Tumor- and Radiation-Related Complications after Ruthenium-106 Brachytherapy in Small to Medium Uveal Melanomas (Part 1)

Abstract

Purpose The purpose of this study was to analyze tumor-related complications after ruthenium-106 brachytherapy in patients with uveal melanoma, with respect to local tumor control, insufficient radiation response, enucleation, and metastasis rate.

Patients/Methods and Materials This retrospective study included 608 patients treated consecutively with ruthenium-106 brachytherapy between January 2008 and December 2010 at the Department of Ophthalmology, University Hospital Essen. The occurrence of radiation-induced results was analyzed by estimating the risk by applying the Kaplan-Meier method, i.e., the “time to event” analysis. The Cox model test was used for the univariate and multivariate risk factor analyses. The median follow-up was 51 months after primary treatment.

Results Tumor recurrence was found in 21 patients (3.5%) and repeated treatment due to insufficient effect after the initial ruthenium-106 brachytherapy was performed in 40 patients (6.6%). The 5-year cumulative risk of recurrence was 4.0% and that of insufficient effect was 7.3%. Thirteen patients (2.1%) underwent a secondary enucleation; 8 because of a local recurrence and 5 because of severe post-brachytherapy complications. The cumulative enucleation risk was 2.3% after 5 years and 2.9% after 10 years, corresponding to eye preservation of 97.7 and 97.1%, respectively. In forty-two patients (7.2%), metastatic disease was diagnosed during the follow-up. The metastatic rate as calculated by the Kaplan-Meier method was 9.0, and 13.1% at 5 and 10 years, respectively.

Conclusion Our study demonstrated that ruthenium-106 brachytherapy is an excellent treatment option for achieving local tumor control and eye preservation in well-selected patients. The metastatic rate is in agreement with that of previous studies analyzing small to medium size uveal melanomas.

Zusammenfassung

Ziel Das Ziel dieser Studie war die Analyse tumor- und strahlenbedingter Komplikationen nach Ruthenium-106-Brachytherapie bei Patienten mit Aderhautmelanom hinsichtlich lokaler Tumorkontrolle, unzureichender Strahlenreaktion, Enukleationsrate und Metastasierungsrate.

Patienten/Methoden und Materialien Diese retrospektive Studie umfasste 608 Patienten, die zwischen Januar 2008 und Dezember 2010 an der Augenklinik des Universitätsklinikums Essen mit Ruthenium-106-Brachytherapie behandelt wurden. Das Auftreten strahleninduzierter Ergebnisse wurde durch Risikoabschätzung mithilfe der Kaplan-Meier-Methode, d. h. der „Time-to-Event“-Analyse, analysiert. Für die univariate und multivariate Risikofaktoranalyse wurde der Cox-Modelltest verwendet. Die mittlere Nachbeobachtungszeit betrug 51 Monate nach der Erstbehandlung.

Ergebnisse Bei 21 Patienten (3,5%) wurde ein Tumorrezidiv festgestellt und bei 40 Patienten (6,6%) wurde eine wiederholte Behandlung aufgrund eines unzureichenden Effekts nach der primären Ruthenium-106-Brachytherapie durchgeführt. Das kumulative 5-Jahres-Risiko eines Rezidivs betrug 4,0% und dasjenige eines unzureichenden Effekts 7,3%. 13 Patienten (2,1%) wurden einer sekundären Enukleation unterzogen: 8 wegen eines Lokalrezidivs und 5 wegen schwerer Komplikationen nach der Brachytherapie. Das kumulative Enukleationsrisiko betrug 2,3% nach 5 Jahren und 2,9% nach 10 Jahren, was einer Augenerhaltung von 97,7% bzw. 97,1% entspricht. Bei 42 Patienten (7,2%) wurde während der Nachbeobachtungszeit eine Metastasierung diagnostiziert. Die mithilfe der Kaplan-Meier-Methode berechnete Metastasierungsrate betrug 9,0% bzw. 13,1% nach 5 und 10 Jahren, entsprechend.

Fazit Unsere Studie hat gezeigt, dass die Ruthenium-106-Brachytherapie eine hervorragende Behandlungsoption zur Erzielung einer lokalen Tumorkontrolle und zum Augenerhalt bei gut ausgewählten Patienten ist. Die Metastasierungsrate stimmt mit der in früheren Studien überein, in denen kleine bis mittelgroße Aderhautmelanome analysiert wurden.

Keywords

uveal melanoma - 106-ruthenium - brachytherapy - epidemiology - choroid - ocular tumors - retina

Schlüsselwörter

Aderhautmelanom - 106-Ruthenium - Brachytherapie - Epidemiologie - Chorioidea - okuläre Tumoren - Retina

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